不同内径胸腔引流管在电视胸腔镜肺叶切除术后的临床应用研究

Clinical Application Research on Thoracic Drainage Tubes with Different Diameters After Video-assisted Thoracoscopic Surgery Lobectomy

目的探讨不同内径胸腔引流管在电视胸腔镜肺叶切除术后应用的可行性及治疗效果。方法将2012年1—12月该院收治的60名电视胸腔镜肺叶切除手术患者随机分为两组,常规组30例,改良组30例,关胸时施行不同的胸腔引流方法。常规组术后胸腔镜切口(腋中线第7或第8肋间)留置内径为20Fr的胸管引流,锁骨中线第1肋间留置内径为8Fr的中心静脉导管引流。改良组术后腋后线第9或第10肋间留置内径为8Fr的中心静脉导管引流,锁骨中线第1肋间留置内径为8F的中心静脉导管引流。比较两组患者在术后疼痛、引流量、拔管时间及肺部并发症等方面的临床效果。结果 80例患者均顺利康复出院,改良组在术后疼痛、引流量、拔管时间等方面优于常规组,差异有统计学意义(P<0.05);在肺部并发症方面,两组间差异无统计学意义(P>0.05)。结论 VATS肺叶切除术后,上下胸部置入中心静脉导管引流能减轻患者的痛苦,减少术后引流量,加快术后患者康复,值得临床推广。

Objective To evaluate the feasibility and therapeutic effect of different diameters closed thoracic drainage tubes after video-assisted thoracoscopic surgery lobectomy.M ethods From January 2012 to December 2012,60 cases undergoing video-as sisted thoracoscopic surgery lobectomy were included in this study and were randomly divided into two groups（Conventional group 30 cases and improved group 30 cases）.The 20Fr thoracic drainage tube was inserted into the incision at the seventh or eighth in tercostal space in middle axillary line,and the 8Fr elbowed central venous catheter was inserted into the first intercostal space in midclavicular line in the conventional group.Comparably,the 8Fr elbowed central venous catheter was inserted into the thoraco scopic observing hole at the ninth or tenth intercostal space in posterior axillary line,and the 8Fr elbowed central venous catheter was inserted into the first intercostal space in midclavicular line in the improved group.Pain score,drainage flow,drainage time and pulmonary complications in two groups were recorded and compared postoperatively.Results There was no difference between two groups in pulmonary complications（P〈0.05）,however,significant difference between two groups in terms of pain score,drainage flow,drainage time was observed,and Pain score,drainage flow,drainage time of theimproved group was superior to that of the conventional group（P0.05）.C onclusion Compared with the patients in the conventional group,the wound pain around drainage tube and drainage flow in patients who were inserted into the 8Fr elbowed central venous catheter in upper and lower chest was reduced after Video-assisted thoracoscopic Surgery Lobectomy.In the meantime,it could fasten recovery for postopera tive patients and was worthy of being widely applied in clinic.